Prevalence of Carbapenem-Resistant Enterobacteriaceae in Seoul, Korea

The prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is increasing globally. However, a few studies have addressed their epidemiology in Seoul, Korea. In this study, we conducted one-year surveillance of CRE among 1,468 clinical isolates of Enterobacteriaceae at the hospital in Seoul with molecular characterization of carbapenemase genes. About 85% of CRE-positive samples were isolated from the elderly age group (above 60 years). The most common isolated organisms were Klebsiella pneumoniae (K. pneumoniae) (56.5%) and Escherichia coli (E.coli) (17.0%). We detected six different Carbapenemase-producing Enterobacteriaceae (CPE) of blaKPC, blaNDM, blaOXA, blaVIM, blaIMP, and blaGES alone or in combination with other bla genes. Typically, 853 (58.1%) isolates were tested positive for at least one CPE. KPC (K. pneumoniae carbapenemase)-2 was the most common CPE type (46.0%) followed by NDM (New Delhi metallo-β-lactamase)-1 (5.9%). KPC-2 was most commonly found in K. pneumoniae (494/676 isolates [73.1%]) and E.coli (107/676 isolates [15.8%]), whereas NDM-1 was commonly found in Enterobacter cloacae complex (20/86 isolates [23.3%]). Detailed information and molecular characteristics of CPE is essential to prevent the spread of these pathogens.

Epidemiology of Legionella and Climatic Variables in Seoul, Korea

Legionella species are abundant in the built environment and are increasingly recognized as a cause of Legionnaires' disease (LD). As the number of cases of Legionnaires' disease acquired by local communities in the Seoul metropolitan area in Korea has been increased, there was concern that changes in environmental factors could affect disease outbreaks. We described the association between climatic variables and occurrence of legionellosis in Korea and Legionella detection rate in Seoul area. A total of 418 cases of legionellosis were reported between 2014 and 2017. There was a seasonal peak in summer. LD continuously occurred from early spring to winter every year and rapidly increased in summer. In the regression analysis, the primary variables of interest- PM2.5 (µg/m³), NO₂ (ppb), and a number of the date of issue O₃ warning were not significant except for average temperature (R²=0.8075). The Legionella detection rate in Seoul, Korea showed a trend similar to precipitation (P=0.708, ANOVA). A relatively high proportion of Legionella detection rate was shown, especially cooling tower (17.7%) and public bath (19.3%). This finding is in line with current understanding of the ecological profile of this pathogen and supports the assertion that legionellosis occurs through contamination of water sources.

Factors Affecting the Self-Management of Adolescents with Type 1 Diabetes Mellitus based on the Information-Motivation-Behavioral Skills Model

PURPOSE: The purpose of this study was to investigate associations between self-management and diabetes knowledge, diabetesrelated attitudes, family support, and self-efficacy in adolescents with type 1 diabetes mellitus based on the information-motivation- behavior skills model. METHODS: Data collection was conducted between March 18 and September 30, 2018. Patients (N=87) aged 12 to 19 years were recruited from the outpatient clinic of S children's hospital and an online community for patient with type 1 diabetes mellitus. Data were analyzed using descriptive statistics, the independent t-test, one-way ANOVA, Pearsons correlation, and hierarchical multiple linear regression with SPSS IBM 23.0, with the two-tailed level of significance set at 0.05. RESULTS: The mean score of self-management in adolescents with type 1 diabetes mellitus was 61.23±10.00 out of 80. The regression analysis showed that self-efficacy and family support significantly explained 56.9% of the variance in self-management (F=21.38, p<.001). Self-efficacy (β=.504, p<.001) and family support (β=.188, p<.001) were significant predictors of self-management. CONCLUSION: It is necessary to develop individual interventions to improve self-efficacy and family support for adolescents with type 1 diabetes mellitus to help them enhance their self-management.

Correlations between a Flexible Parental Visiting Environment and Parental Stress in Neonatal Intensive Care Units

PURPOSE: The purpose of this study was to examine the correlation between a flexible parental visiting environment and parental stress in neonatal intensive care units (NICUs).METHODS: The study participants included 60 parents of premature infants in NICUs. Structured questionnaires and interviews, as well as observations by researchers using a caregiving behavior checklist, were used to measure the flexibility of the parental visiting environment and parents' stress levels. Quantitative and qualitative data were collected concurrently and were initially analyzed as separate data sets. Data collection extended from March 11, 2018 to June 30. 2018 and the data were analyzed using descriptive statistics, the independent t-test, one-way analysis of variance, and Pearson correlation coefficients.RESULTS: There was a negative correlation (r=−.30, p=.021) between parental stress and the total number of visits in 7 days. We also found that the average duration of each visit and the number of caregiving behaviors performed by parents were positively correlated (r=.73, p<.001).CONCLUSION: When designing a flexible visiting environment for parents, parents should be encouraged to visit their babies. By doing so, stress can be reduced both for babies and for parents. Therefore, it is suggested that the related polices and regulations in South Korea should be changed to provide more a flexible visiting environment to promote better parent-child attachment and family adjustment.

Molecular Characterization of Enterotoxigenic Escherichia coli in Foodborne Outbreak

Diarrheagenic Escherichia coli (E. coli) is a main cause of diarrhea worldwide. This study reports the investigation on the occurrence of enterotoxigenic E. coli (ETEC) serotype O27:H7-associated foodborne gastrointestinal disease that occurred at two schools, one middle school and one high school, in Seoul, Korea in June 2015. The immediate government investigation in 1,216 students and 19 food handlers in these two schools revealed that 116 students, 32 students in the middle school and 84 students in the high school, and 2 food handlers, one from middle school and the other from high school, developed gastrointestinal illness symptoms including diarrhea. Following lab investigation identified 29 ETEC serotype O27:H7 strains, 27 from 116 students and 2 from 19 food handlers. Pattern of pulsed-field gel electrophoresis analysis of ETEC isolates suggested that ETEC serotype O27:H7 caused the diarrheal outbreak in June 2015 in Seoul, Korea was a specific clone. In addition, these ETEC serotype O27:H7 isolates were highly resistance to the several antibiotics. The results from the present study provide the evidence that ETEC serotype O27:H7 can be an important cause of domestic foodborne outbreak in Korea.

Development of Educational Material for Blood Donor Interview through the Cognitive Evaluation of Donor History Questionnaires / 대한수혈학회지

BACKGROUND: Screening for healthy blood donors through donor interviews is essential to the safety of donors and blood resources. Our goal was to suggest educational material for donor interviewers and donors, as well as supplemental material for interview sites, which will help provide an effective interview process. METHODS: We conducted surveys regarding experiences in donor interviews from donor interviewers and cognitive interviews about difficulties during interview from blood donors between September and October of 2015. We additionally conducted a post-survey about provided educational and supplemental materials between December 2015 and January 2016. RESULTS: The possibility of an incorrect answer in the donor history questionnaire (DHQ) was high for questions about sexual contact, imprisonment, or medication, and the reasons were incorrect memories, ignorance about donor interview, or protection of privacy. Cognitive interviews of donors revealed questions and terminology that are difficult to understand. Donor interviewers could obtain improved understanding of the DHQ through educational materials, which were found to be useful for new interviewers or donors. Use of a supplemental flip book for the interview process was found to be useful, especially for blood centers with small blood donations. CONCLUSION: This study investigated difficulties in the donor interview from the perspective of donor interviewers and donors and suggested educational and supplemental materials to address these difficulties. These materials will induce correct and honest answers from blood donors through education and guidance about the donor interview process and help secure the safety of blood products.

A Comparative Study of Family Management Style According to Severity of Childhood Atopic Dermatitis

PURPOSE: This study of secondary analysis aims to compare family management style according to severity in children with atopic dermatitis. METHODS: convenience sample of 109 Korean mothers caring for a child with atopic dermatitis, were recruited from the pediatric departments of two general hospitals in Seoul. Data were collected from November 1, 2015 to February 28, 2016. A structured self-report questionnaire was used. Data were analyzed using descriptive statistics, correlation analysis, and one-way ANOVA with IBM SPSS Version 22.0. RESULTS: For family management style, condition management effort, family life difficulty, and view of condition impact were significantly different according to the severity of the atopic dermatitis in these children. CONCLUSION: The findings indicate that family management strategies to enhance care of children with atopic dermatitis as well as members of the family should include these significant variables in a family-centered approach.

Parent Involvement Intervention in Developing Weight Management Skills for both Parents and Overweight/Obese Children

PURPOSE: The purpose of the study was to evaluate a parent involvement intervention for childhood obesity intended to increase parents' skills in managing children's weight-related behavior and to improve child-parent relationships. Many studies reported on parental influence on childhood obesity, emphasizing parent involvement in prevention and management of childhood obesity. METHODS: A randomized controlled trial was conducted. Forty-two parents of overweight/obese children were recruited from four cities and randomized to the experimental group or control group. The parental intervention was provided only to parents in the experimental group and consisted of weekly news-letters and text messages for a period of 5 weeks. Exercise classes and nutrition education were provided to all children. Lifestyle Behaviour Checklist and the Child-Parent Relationship Scale (CPRS) were used for measurement of parent outcome. For the child outcome, dietary self-efficacy, exercise frequency, and body mass index were measured. A mixed-design analysis of variance was performed with city location entered as a random effect. RESULTS: After the intervention, CPRS of parents and dietary self-efficacy of children showed an increase in the experimental group (p < .05). Intervention effects differed significantly according to the city location regarding the control efficacy of parents and dietary self-efficacy of children (p < .05). CONCLUSIONS: The results support the effectiveness of the parent involvement intervention in promoting child-parent relationship and dietary self-efficacy of children. However, a 5-week parent involvement intervention was not sufficient to produce significant changes in children's body mass index. Further research is needed to investigate effects of parent involvement intervention with long-term evaluation.

Development and Evaluation of the Empowering A Self-Efficacy (EASE) Program for Children with Epilepsy

PURPOSE: The purpose of this study was to verify effects of the Empowering A Self-Efficacy (EASE) program on self-efficacy, self-management, and child attitude toward illness in children with epilepsy. METHODS: This was a quasi-experimental study with a non-equivalent control group pre-post test design. Participants were 10 to 15 year old children with epilepsy (11 in the experimental group and 10 in the control group) who were registered at one hospital in S city. The experimental group received the EASE program for 3 weeks. In the first week, a group meeting lasting 570 minutes was conducted on a single day. Over the next two weeks, telephone counselling was conducted twice a week. Data were analyzed using SPSS 18.0. RESULTS: There was a significant difference of pre-post evaluation of the epilepsy self-management scores in the experimental group. However, differences between the experimental group and the control group for seizure self-efficacy and child attitude toward illness were not significant. CONCLUSION: This is the first study in Korea to develop and evaluate an intervention program for children with epilepsy. Further studies are needed to confirm the effects of the EASE program.

Global Health Competencies for Undergraduate Nursing Students in Korea / 한국간호교육학회지

PURPOSE: The purpose of this study was to identify essential global health competencies for undergraduate nursing students in Korea. METHODS: This study used a mixed methods design including an online survey with a convenient sample of 223 nursing educators, followed by an expert discussion with four nursing educators with expertise in global health. The global health competency was measured using the Global Health Competencies for Nurses in the America, which consists of 30 competencies in 6 domains. Each competency was measured by a 4-point Likert Scale, with at least 80% of 3 or 4 point scores indicating consensus that competency was considered essential for undergraduate nursing students. RESULTS: Nursing educators most strongly agreed the competencies of the Social and Environmental Determinants of Health domain as essential global health competencies for nursing students. A total of 21 items in 5 out of 6 competency domains were initially identified with at least 80% agreement. Finally, the experts decided on 24 global health competencies through the revision and integration of several competencies. CONCLUSION: The findings indicate that nursing educators perceived that nursing students need to be prepared for responding to emerging global health needs. The proposed list of global health competencies can provide guidance to develop a framework for integrating global health into undergraduate nursing curriculums.

Estimation of Effects of Factors Related to Preschooler Body Mass Index Using Quantile Regression Model

PURPOSE: The purpose of this study was to investigate Korean preschoolers' obesity-related factors through an ecological approach and to identify Korean preschoolers' obesity-related factors and the different effects of ecological variables on body mass index and its quantiles through an ecological approach. METHODS: The study design was cross-sectional. Through convenience sampling, 241 cases were collected from three kindergartens and seven nurseries in the Seoul metropolitan area and Kyunggi Province in April 2013 using self-administered questionnaires from preschoolers' mothers and homeroom teachers. RESULTS: Results of ordinary least square regression analysis show that mother's sedentary behavior (p < .001), sedentary behavior parenting (p = .039), healthy eating parenting (p = .027), physical activity erelated social capital (p = .029) were significant factors of preschoolers' body mass index. While in the 5% body mass index distribution group, gender (p = .031), preference for physical activity (p = .015), mother's sedentary behavior parenting (p = .032), healthy eating parenting (p = .005), and teacher's sedentary behavior (p = .037) showed significant influences. In the 25% group, the effects of gender and preference for physical activity were no longer significant. In the 75% and 95% group, only mother's sedentary behavior showed a statistically significant influence (p < .001, p = .012 respectively). CONCLUSION: Efforts to lower the obesity rate of preschoolers should focus on their environment, especially on the sedentary behavior of mothers, as mothers are the main nurturers of this age group.

Posture Management Program Based on Theory of Planned Behavior for Adolescents with Mild Idiopathic Scoliosis

PURPOSE: The purpose of this study was to evaluate the effects of a devised posture management program based on the Theory of Planned Behavior in adolescents with mild idiopathic scoliosis. METHODS: A quasi-experimental study was conducted. It involved a nonequivalent comparison group design with pretest and posttest. Forty-four female adolescents with mild idiopathic scoliosis participated; data from 35 participants (20 for the test group, 15 for the control group) were used for the final analyses. The devised posture management program ran for 6 weeks. Posture management behavioral determinants (attitude, subjective norms, perceived behavioral control, and behavioral intention) as cognitive outcomes and muscular strength and flexibility as physical outcomes were measured three times: at baseline, week 6 and week 8. Cobb's angle as another physical outcome was measured twice: at baseline and week 8. Descriptive analysis, repeated measures analysis of variance and t test were used for data analyses. RESULTS: Attitude, perceived control, and behavioral intention were consistently enhanced by the posture management program. The intervention increased flexibility and muscular strength and decreased Cobb's angle, which reduced spinal curvature. Frequency of posture management exercise showed a gradual increase in the test group. CONCLUSION: The results indicate that the posture management program is effective in maintaining posture management behavior in adolescents with mild idiopathic scoliosis for both cognitive and physical outcomes. The posture management program should be helpful in expanding the role of school nurses in improving the health status of adolescents with mild idiopathic scoliosis.

An Emotional Self-Regulation Program for Obese Children: Pilot Study Using Mixed Methods

PURPOSE: The purpose of the study was to develop an emotional self-regulation program for obese children and to examine the program's effectiveness on depression, eating habits, and body mass index. METHODS: The emotional self-regulation program was developed from theory-based strategies and a pre-post pilot study was conducted with 46 children (19: intervention, 27: control). The program included 6 weekly group sessions over 2 months. The embedded experimental model of concurrent mixed methods was used to better understand research outcomes by converging both quantitative and qualitative data. Anthropometric measurements and surveys were performed before and after the intervention. Three focus group interviews were conducted with all participants after intervention to explore their experiences. RESULTS: The intervention group displayed decreased depression levels in the quantitative outcomes. The participants also expressed positive outcomes such as improvements in confidence, impulse management, intimacy, happiness, and losing weight. CONCLUSION: These findings suggest that emotional self-regulation skills are crucial factors for obese children not only to manage their emotional problems but also to control their weight. Further research is needed with a larger sample size and randomized controlled trials.

Testing the Biobehavioral Family Model in Understanding the Eating Problems of Adolescent Girls

PURPOSE: This study was done to test a hypothesized model, the Biobehavioral Family Model (BBFM), on the relationship of family emotional climate, security of parent-child relationship, depression symptoms and eating problems in adolescent girls, to further understanding of eating problems in this population. METHODS: With a convenience sample of 647 girls, aged 15 to 18, a self-report survey was conducted which included the Korean form of the Eating Attitude Test (EAT-26) to assess eating problems. RESULTS: The estimated results of the structural equation modeling indicated a good fit of data to the hypothesized model proposing that family emotional climate and security of parent-child relationship were associated with the risk of eating problems by way of depression symptoms. That is, negative family emotional climate and insecure parent-child relationship increased the risk of eating problems indirectly by way of depression symptoms. CONCLUSION: The findings are consistent with the BBFM, which suggests a psychobiologic influence of specific family processes on children's stress-sensitive physical disease activity by way of depression symptoms. Therefore, the applicability of the BBFM for understanding adolescent girls' eating problems is supported. The psychobiologic pathways from depression to eating pathology should be addressed in future studies.

Development and Evaluation of a Scenario for Simulation Learning of Care for Children with Respiratory Distress Syndrome in Neonatal Intensive Care Units

PURPOSE: This study was done to develop a scenario and evaluate student performance in simulation learning of care for children with respiratory distress syndrome in neonatal intensive care units. METHODS: To test the application effect, a one group pre-test design was applied. The scenario based on actual patients and textbook material was developed through several meetings of experts. The scenario was used with 17 groups of 55 senior nursing students who participated voluntarily. RESULTS: Contents were organized focusing on the nursing process for simulation learning. In the application of knowledge and skills, nursing students had high scores in the contents of observation of oxygen saturation, and care to relieve dyspnea. Participants' ability, especially in suction and oxygen supply in the evaluation of objective structured clinical examination was not adequate. There was a significant positive correlation between problem-solving ability and satisfaction in learning. CONCLUSION: The respiratory distress syndrome simulation scenario developed in this study was an effective tool to give students experience in problem solving and critical thinking ability under conditions similar to reality. The development of various scenarios for child nursing care is needed.

Parenting Stress in Mothers of Premature Infants

PURPOSE: The purposes of this study were to assess the parenting stress in mothers of premature infants and stress related characteristics of mothers and infants. METHODS: The methodology was a cross sectional survey study using self-report questionnaires. Participants in this study were 36 mothers of infants with corrected ages of 4 months to 12 months who were born prematurely. Data were analyzed using t-test, ANOVA, and Pearson correlation with the SPSS WIN 19.0 program. RESULTS: The mean score for parenting stress in mothers of premature infants was 74.639+/-17.570, indicating that the mothers actually experienced stress. When mothers were able to have some private time, parenting stress was statistically significantly lower. When the residential status was having one's own house and the local community provided informational support regarding child nurturing, there was a statistically significant decrease in the sub-category of particular infant temperament. There was a statistically significant positive correlation between mothers' depression and parenting stress. CONCLUSION: These results indicate that there is a need for nursing interventions to increase mothers' private time and to include informational support regarding health management of children including developmental status assessment from local communities.

Health Disparity and Health Welfare among Children from Low-Income Families

Children from low income families are vulnerable to physical problems including obesity, asthma, hypertension and psychological problems including depression, anxiety. This study was done to identify trends in welfare policy for children from low-income families and future direction for solving health disparity problems. Dream Start is a government-sponsored project that offers services for vulnerable children, ages 0 (include pregnant woman) to 12 years and their families. The Korean Government has made an effort to alleviate health disparity through the 'Health Plan' by establishing health objectives. However, in spite of these efforts by the Korean government, health disparity has worsened in Korea. In order to strengthen family function as well as promote growth and development for vulnerable children, experts in child care need to be significantly involved in identifying neglected children in the community.

Home Visitation Screening for Child Abuse Assessment in Korea

PURPOSE: The purpose of this study was to facilitate home visits to assess the current rate of child abuse in order to provide an agenda for the early detection and prevention of child abuse and neglect in Korea. METHODS: For this retrospective descriptive research, 20 public health centers were selected, 1,991 families were visited and 2,680 children were assessed. RESULTS: We found 415 cases (15.5%) of potential abuse and 7 cases (0.3%) of actual abuse. The greatest risk group was to children age 4 to 6 years. According to the HOME Inventory, there were 17 infants (5.8%) presenting a potential risk for child abuse and neglect. CONCLUSION: Visitation screening is highly recommended for prevention in the high-risk preschool age group.

Factors Influencing Readmission of Home Ventilator-Assisted Children

PURPOSE: This study was conducted to analyze factors affecting readmission of children with home ventilator care. METHODS: To collect patient data, a retrospective chart review was done of medical records of children admitted between June 1, 2007 and May 31, 2010 at one children's hospital located in Seoul. During that period 30 children were discharged with a home ventilator. RESULTS: Twenty-one of these children had a total of 63 readmissions during the study period, averaging 2.1 readmissions per child with a mean duration of hospitalization of 7.4 days. Children with nasogastric tubes were more frequently readmitted (t=7.232, p=.012) and duration of hospitalization was significantly longer (t=4.761, p=.038). Children who had cardio-pulmonary comorbidity were more frequently readmitted and had longer hospitalization than children without comorbidity (t=5.444, p=.027). When home ventilator assisted children were admitted via emergency room, they were hospitalized longer (t=14.686, p<.001). Cardio-pulmonary morbidity and readmission via ER explained 38.1% of variation for readmission. Feeding method explained 15.0% of variation in length of hospitalization. CONCLUSION: The results suggest that health care providers must give individualized education on home ventilator care to parents with children who are at risk for readmission due to cardio-pulmonary comorbidities, nasogastric tube, or readmission via ER.

Biobehavioral Characteristics and Risk Factors Related to Obesity in School Age Children Participating in a Health Camp

PURPOSE: The purpose of the study was to identify differences in physiological.psychological.environmental.behavioral characteristics between obese and control children participating in a health camp and to identify the factors related to childhood obesity. METHODS: Two hundred eighty seven children aged 6 to 12 years were recruited from a health camp for elementary students in D city, Korea. Data collection was done on November 28 and 29, 2009. Anthropometric measurements, blood tests, and self-report surveys were conducted. Chi-square test, independent t-test, ANCOVA, and multiple logistic regression were performed using PASW statistics 18.0. RESULTS: Obese children had adverse conditions for both physiological and psychological characteristics. In terms of environmental and behavioral characteristics, high maternal BMI and more than two hours of TV watching were significantly associated with high risk of childhood obesity (OR=1.11, 95% CI=1.02-1.21; OR=2.05, 95% CI=1.23-3.41). CONCLUSION: Through a multi-factorial approach, the current study identified the differences between obese and control children participating in a health camp and risk factors of childhood obesity. These findings provide preliminary data and perspectives on intervention research for prevention and management of childhood obesity.